Archive for the ‘Health Insurance Exchanges’ Category

Healthcare Business Year in Review: A Look Back at 2013’s Top Stories

January 9th, 2014 by Cheryl Miller

From an early surge in Medicare accountable care collaborations to the rocky introduction of ACA-mandated health insurance exchanges during a government shutdown, healthcare in 2013 was nothing short of unpredictable.

But in this issue, as in “Best of” issues past, we bring you the stories that resonated most with you. Your top story was one that ran nearly a year ago: Post-Hospital Telephonic Outreach Reduces Readmissions by 22 Percent for High Risk Patients. This initiative from Cigna monitored telephonic outreach by health plan case managers within 24 hours of hospital discharge, finding that they reduced future readmissions by 22 percent. Resulting in more physician visits and prescription drug fills, the timing and prioritizing of the calls was critical to its success.

Case managers’ roles in long term care also spiked your interest in our featured white paper: Case Management in 2013: Achieving Results with Cardiovascular Disease; Long-Term Care Next Frontier for Embedded Case Managers. As care coordination by healthcare case managers continues to drive clinical and financial outcomes in population health management, expect to see lots more case managers — not just coordinating care telephonically like Cigna, but co-located in nursing home, long-term care (LTC) and assisted living settings.

Other top stories included CMS’ announcement that Medicare beneficiaries saw significant out-of-pocket savings due to the ACA, including provisions to close the prescription-drug “donut hole” that saved more than 7.1 million seniors and people with disabilities $8.3 billion on their prescription drugs since it took effect.

How the ACO model figures in most hospitals’ futures also topped your reading list, as did a story on how 24 states and the District of Columbia chose a benchmark health insurance plan that met the ACA’s essential health benefit requirement, which is scheduled to begin next month, January 2014. Researchers found that 19 of the states that selected plans chose existing small-group plans, employer-based plans for businesses with fewer than 50 employees. The remaining five states selected HMO or state employee benefit plans.

An infographic on 2013’s Most Significant Healthcare Issues, and our podcast on Physician Hospital Organizations: Developing a Collaborative Structure for Shared Savings Agreements also attracted the most views.

We will continue to provide you with the kind of up-to-the-minute coverage you need to stay informed.

And as with issues past, we send our best wishes to all of you for a happy, healthy, prosperous and peaceful new year.

Infographic: Are Young Invincibles Eligible for Medicaid?

January 8th, 2014 by Jackie Lyons

Approximately 5.4 million uninsured young adults, ages 19 to 34, also known as ‘young invincibles’ are now eligible for Medicaid, according to a new infographic from The Urban Institute.

This infographic also summarizes who the ‘young invincibles’ are and how they can be identified and enrolled in insurance plans.

Medicaid and the Young Invincibles

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You may also be interested in this related resource: Next-Generation Insurance Benefit Design and Marketing.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Healthcare Business Week in Review: Infectious Disease Threats, Health Insurance, Bundled Payments

December 23rd, 2013 by Cheryl Miller

From antibiotic-resistant superbugs to salmonella to the seasonal flu, infectious diseases are disrupting lives throughout the country at an alarming rate, and driving up medical costs, and most states are unable to counter them, according to a report by Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF).

The problem? Outdated systems and limited resources. In fact, 34 states scored five or lower out of 10 key indicators of policies and capabilities to protect against infectious disease threats.

One solution offered in this comprehensive analysis is to be more vigilant with vaccinations; only one-quarter of states vaccinated at least half of their population against the seasonal flu, which affects 20 percent of Americans each year. Details inside.

Rising medical costs were the primary driver of recent rate increases by health insurers, accounting for three-quarters or more of the larger premium hikes requested between July 2012 and June 2013, a new Commonwealth Fund study finds.

The analysis is the first such report to take a national look at the explanations insurers file with federal and state authorities to justify rate increases of 10 percent or more, as required by the ACA. Currently, insurers are only required to submit rate increase explanations for non-grandfathered plans, or those plans that became available after the enactment of the health reform law.

People whose existing healthcare insurance has been canceled because of the ACA will not be hit with tax penalties for failing to line up new coverage as required under the law, according to Health and Human Services Secretary Kathleen Sebelius. Under a “temporary hardship exemption,” they will be able to buy a bare-bones catastrophic plan regardless of their age.

Reducing health insurance premiums is one strategy employers are using to incent their employees to self-manage their health. Healthcare companies have grown increasingly creative in their use of economic and benefit-based incentives to drive engagement and participation in health and wellness programs, according to Healthcare Intelligence Network research.

Reducing joint replacement payments – specifically knees, which, at 600,000 annually, are the most commonly performed knee replacement procedure in the United States – is the aim of Florida Blue and Mayo Clinic’s knee replacement bundled payment agreement, first introduced in 2012. They have announced they are extending it, and their overall network agreement to include thousands of Florida Blue’s commercially insured members throughout the state who are now able to access Mayo Clinic as an in-network provider.

And lastly, there is no replacement for a little TLC, in the form of paraprofessionals or nurses visiting the homes of low income pregnant women and their children. Researchers from the University of Colorado School of Medicine found that these helpers, part of the Nurse-Family Partnership, helped improve the health and development outcomes for the children ages six through nine.

Infographic: Health Insurance in the Individual Market

December 20th, 2013 by Jackie Lyons

So far in 2013, the healthcare market has been unpredictable and volatile. The Affordable Care Act (ACA) continues to affect millions of individuals and numerous aspects of healthcare.

Only 5.7 percent of Americans buy their health insurance through the individual insurance market, according to a new infographic from Families USA. This infographic breaks down the ACA, the healthcare insurance market and more.

Health Insurance in the Individual Market

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You may also be interested in this related resource: Plunkett’s Health Care Industry Almanac 2014.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: How Will the ACA Affect Senior Citizens?

December 18th, 2013 by Jackie Lyons

The Affordable Care Act (ACA) will cut Medicare funding by $716 billion from 2013 to 2022, according to a new infographic from AssistedLivingFacilities.org. This has several implications for high-income earners and low-income Medicare beneficiaries alike.

This infographic includes a summary of Medicare and the health insurance marketplace, data on prescription drugs and doctor shortages, the impact of Medicare cuts on individuals and healthcare in general, and more.

How Will the ACA Affect Senior Citizens?

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You may also be interested in this related resource: Changing the U.S. Health Care System: Key Issues in Health Services Policy and Management, 3rd Edition.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: Medicare Made Clear

December 9th, 2013 by Jackie Lyons

More than one in five Medicare beneficiaries say Medicare benefits are confusing, according to a new infographic from UnitedHealth Group. Furthermore, nearly 40 percent of baby boomers aren’t aware they could face penalties on their monthly premium if they don’t enroll in Medicare when eligible at 65.

This infographic also addresses what patients do know about Medicare, as well as effects of the Affordable Care Act, the prevalence of out-of-pocket expenses and the percent of seniors who have never shopped for Medicare coverage.

Medicare Made Clear

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You may also be interested in this related resource: Guide to Dual Eligibles Care Coordination.

Infographic: Executive Perspective on the Healthcare IT Landscape

December 6th, 2013 by Jackie Lyons

The top healthcare IT priority of healthcare executives is implementing ICD-10, while the most significant barrier is a lack of staffing resources, according to a new infographic from Praetorian Guard.

This infographic illustrates highlights of a web-based survey that garnered responses from professionals representing nearly 600 U.S. hospitals. The infographic addresses health IT security concerns, budgeting and staff needs, meaningful use, and health insurance exchanges and investments.

Executive Persepective on the Healthcare IT Landscape

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You may also be interested in this related resource: Health IT in Care Management to Improve Health and Effect Behavior Change.

Infographic: Predicted Benefits for Physicians

November 29th, 2013 by Jackie Lyons

In spite of the initial issues with the implementation of the Affordable Care Act (ACA), there are predicted benefits for physicians and U.S. citizens alike.

The ACA will lead to estimated savings of about $190 billion in the federal budget during the next 10 years, which will lower the healthcare deficit to 174 percent, according to a new infographic from Medical Billing Star. This infographic also shows ACA statistical data, new insurance payors, predicted coverage and more.

Obamacare – A Precursor for Financially Sound Healthcare Practice

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You may also be interested in this related resource: Healthcare Trends & Forecasts in 2014: Performance Expectations for the Healthcare Industry .

Infographic: A Majority of Eligible Adults Likely to Shop for Coverage in Health Insurance Marketplaces

November 25th, 2013 by Jackie Lyons

Open enrollment in a health plan that covers essential benefits and pre-existing conditions continues until March 31, 2014. But what do we know about experiences with the health insurance marketplaces thus far?

Seventeen percent of eligible adults went to their state’s marketplace in October to shop for a health plan, according to a new infographic from the Commonwealth Fund. The infographic also documents awareness of the marketplace, ages of those who shopped, enrollment percentages and those likely to shop for a plan in the near future.

A Majority of Eligible Adults Likely to Shop for Coverage in Health Insurance Marketplaces

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You may also be interested in this related resource: Health Insurance Exchanges: Product Design, Promotion and Positioning.

Infographic: Healthcare.gov is Fundamentally Flawed

November 22nd, 2013 by Jackie Lyons

The launch of the healthcare.gov website was plagued with large-scale problems, and some of the issues have yet to be fixed.

Only .38 percent of visitors- or 36,000 people – were able to complete enrollment on the healthcare.gov website, according to a new infographic from Healthcare-Administration-Degree.net. This infographic also outlines specific issues with the site, market efficiency, repercussions of centralizing health data and more.

Healthcare.gov is Fundamentally Flawed

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You may also be interested in this related resource: The Financial Professional’s Guide to Healthcare Reform.